Normalization of pregnancy outcome in pregestational diabetes through functional insulin treatment and modular out-patient education adapted for pregnancy.

AIM: To investigate whether modular out-patient group education for flexible, Functional Insulin Treatment (FIT) adapted for pregnancy can eliminate diabetes-associated neonatal complications in pregestational diabetes. RESEARCH DESIGN AND METHODS: Outcome analysis of the modular out-patient group education and FIT based on separate insulin dosages for fasting, eating or correcting hyperglycaemia in 76 consecutive pregnancies (in 20 cases first after conception) of 59 patients with pregestational diabetes (Type 1 diabetes, n = 54). CONTROLS: (a) diabetic pregnancies: historical controls; (b) non-diabetic pregnancies: retrospective case-controlled study; (c) population-based data of all Austrian newborns registered within the respective time period. RESULTS: HbA1c of 113 +/- 18% of mean value (= 100%) of non-diabetic, non-pregnant population (103 +/- 14% during the last pregnancy trimester), and self-monitored blood glucose of 5.6 +/- 0.7 mmol/l (5.3 +/- 0.7 mmol/l during the last trimester) was achieved throughout all FIT pregnancies. Severe hypoglycaemia occurred in 14 pregnancies. The gestational age at delivery was 39.2 +/- 1.5 weeks (four cases (5.4%) < 37 weeks) with a birth weight of 3305 +/- 496 g. Four newborns (5.3%) were above the 90th, and nine (11.8%) below the 10th percentile for weight of reference population-based data. Hypoglycaemia was recorded in six newborns (8%). Malformations were found in two infants whose mothers booked for diabetes FIT education only after conception. The caesarean delivery rate was 25%. In comparison with historical diabetic pregnancy controls we demonstrated a reduction in major complications, and compared with non-diabetic women, a lowering of diabetes-related neonatal complication rates to general population levels. CONCLUSIONS: Structured, comprehensive, modular out-patient group education promoting self-choice of insulin dose for flexible, normal eating prior to conception normalizes pregnancy outcome in diabetes.

[Regular exercise therapy in disorders of carbohydrate metabolism in pregnancy--results of a prospective, randomized longitudinal study]. / Regelmässige Bewegungstherapie bei Kohlehydratstoffwechselstörungen in der Schwangerschaft--Ergebnisse einer prospektiven, randomisierten Longitudinalstudie.

Regular exercise has long been known as an adjunct in the therapy of diabetes mellitus. There are, however, only few reports on the impact of this therapy during pregnancy. This study aims at presenting an exercise programme for patients with insulin-requiring gestational diabetes (GDM) and its short-term and long-term effects on carbohydrate metabolism, on the foetus and on the course of pregnancy. Between the 26th and 32nd week of gestation, 41 pregnant subjects were randomised into either an exercise and diet group (EXE) or an Insulin and diet group (INS). The EXE patients (N = 21) trained three times per week at 50% VO2max. For 3 x 15 minutes on a recumbent bicycle ergometer throughout pregnancy with blood glucose monitoring before and after exercise). Blood glucose metabolism was followed by daily home monitoring and weekly fasting blood glucose sampling (FBG). The FBG results were comparable in the study and the control group (< 105 mg/dl); the maternal and foetal complications did not differ significantly between the two groups. The glycaemic parameters indicate a persistent decrease in blood glucose and an increase in insulin sensitivity induced by regular physical activity. We conclude, that such a medically supervised exercise programme can be safely conducted in women with GDM resulting in normoglycaemia for the mother and thus preventing insulin therapy.

The impact of preconception counseling on pregnancy outcomes. The experience of the Maine Diabetes in Pregnancy Program.

OBJECTIVE: To determine if a noncentralized, statewide program could be established to educate health-care providers and women with pregestational diabetes on available strategies to prevent adverse outcomes in pregnancies complicated by diabetes. Characteristics of women who participated in the program and the outcomes of their pregnancies are evaluated. RESEARCH DESIGN AND METHODS: A network of regional providers caring for pregnant women with diabetes was developed. Continuing education sessions were delivered to both providers and women with existing diabetes on the importance of preconception counseling. RESULTS: Maine health-care providers collaborated on the development and adoption of three patient-care guidelines that address preconception counseling, prenatal care, and contraception for women with established diabetes. A total of 185 pregnancies among 160 women with pregestational diabetes reporting estimated delivery dates between 1 January 1987 and 31 December 1990 were identified. Of the total pregnancies, 62 (34%) occurred in women who received preconception counseling: among these 62 pregnancies were one major congenital defect (1.6%) and four fetal or neonatal deaths (6.4%). Among the 123 (66%) pregnancies occurring in women that had not received preconception counseling, 8 (6.5%) infants were born with congenital abnormalities, and 26 (21.1%) fetal or neonatal deaths were documented. CONCLUSIONS: A program promoting preconception counseling can be implemented on a statewide basis by using various health-care providers to deliver the program. Participation in such a program appears to be related to improved pregnancy outcomes among women with pregestational diabetes.

Pre-conception counselling in Asian women with non insulin dependent diabetes and impaired glucose tolerance.

Asian patients comprise greater than 8% of our diabetic clinic. Retrospective analysis of the case notes of 22 Asian patients and 20 white patients with NIDDM or impaired glucose tolerance (IGT) attending our combined diabetic/antenatal clinic during 1985-1987 confirmed the reported advantages of pre-conception counselling. Those Asian patients with NIDDM or IGT had higher corrected birthweight than a parity matched Asian control group (3,472.3 +/- 595 g v 2,798.6 +/- 672.3 g p less than 0.001). Those Asian patients who had preconception counselling had, however, significantly smaller babies (3,270.8 +/- 445.1 g v 3,714.4 +/- 727.1 g p less than 0.05). An increase in foetal and maternal complications has been documented in cases of gestational diabetes, but the glucose levels that predict an increased risk have not been clearly defined. In the Asian patients with NIDDM/IGT there was one neonatal death and two congenital abnormalities, although these mothers did not have significantly higher glycosylated haemoglobin levels. HbA1 was not a good diagnostic test for glucose tolerance. Subjects with any degree of glucose intolerance should be managed as carefully as established diabetics and preconception counselling for high risk groups may be beneficial.